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Drug&ETOH Flashcards

1
Q

What is the precontemplation stage of Prochaska and DiClemte’s stages of change model?

A

There is no interest in change in the foreseeable future

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2
Q

What is the contemplation stage of Prochaska and DiClemte’s stages of change model?

A

Change may be considered in the next 1-6 months

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3
Q

What is the preparation stage of Prochaska and DiClemte’s stages of change model?

A

Change is planned in the next month

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4
Q

What is the action stage of Prochaska and DiClemte’s stages of change model?

A

Meaningful changes has been made in last month

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5
Q

What is the maintenance stage of Prochaska and DiClemte’s stages of change model?

A

Changes are maintained for 6 months or more

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6
Q

If a pregnant woman decides to withdraw from heroin/opiates which trimester should she do it?

A 
2nd trimester
(1st trimester = high risk of miscarriage, 3rd trimester = high risk of prematurity)
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7
Q

Which medication is recommended for use in opiate withdrawal in pregancy?

A

Methadon

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8
Q

What does the FRAMES acronym stand for?

A 
Feedback of risks
Responsibility highlighted
Advised to abstain/cut down
Menu of alternative options/activities offered
Empathic interviewing
Self-efficacy enhanced regularly

(features of effective brief interventions for substance use)

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9
Q

Which symptoms would someone with heroin dependence not develop tolerance to?

A

Constipation

Miosis

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10
Q

What are the effects of LSD?

A
  • heightening of perception
  • distortion of shape
  • intensification of colour and sound
  • apparent movement of stationary objects
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11
Q

Do you get physical withdrawal symptoms from LSD?

A

No

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12
Q

What type of hallunications are present in amphetamine intoxication?

A

visual

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13
Q

is there any benefit of supervised injectable heroin/methadone over optimised oral methadone in health and social outcomes?

A

No

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14
Q

What are somee of the complications of chronic use of khat?

A
  • hallucinations
  • impaired inhibition
  • diminished sexual drive
  • psychosis
  • increased risk of MI
  • increased risk of oral cancer
  • increase in suicidal ideation
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15
Q

What are the acute effects of khat?

A

Similar to amphetamines:

  • euphoria
  • excitement
  • loss of appetite
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16
Q

Which medications can help with strong cravings in alcohol abstinence (especially after if there has already been one relapse)?

A

Naltrexone (opioid antagonist)

Nalmefene (opioid receptor modulator) - PRN

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17
Q

Length of time that phencyclidine can be detected in a urine drug screen

A

8 days

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18
Q

Length of time that MDMA/ecstacy can be detected in a urine drug screen

A

48 hours

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19
Q

Length of time that amphetamine can be detected in a urine drug screen

A

48 hours

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20
Q

Length of time that LSD can be detected in a urine drug screen

A

24 hours

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21
Q

What are the signs of phencyclidine (PCP) intoxiation?

A

violent behavior

nystagmus

tachycardia

hypertension

anesthesia

analgesia

Impaired motor function

Dysarthria

Hallucinations, delusions, paranoia

Depression

Synaesthesia

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22
Q

What is phencyclidine (PCP)?

A

Dissociative anaesthetic agent

NMDA receptor antagonist

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23
Q

What is 3,4-Methyl​enedioxy​methamphetamine (ecstacy/MDMA)?

A

Serotonin neurotoxin

-produces stimulant and mild hallucinogenic effects

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24
Q

Does tolerance develop with MDMA?

A

Yes, subsequent doses have less potensy

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25
Q

What is LSD?

A

5-HT2A agonist and most potent hallucinogen

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26
Q

Which drugs have no recognised withdrawal syndromes?

A

ketamine and LSD

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27
Q

How quick is the onset of the “trip” with LSD?

A

Very quick ~15 mins orally which is why it is uncommon to inject

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28
Q

Early signs of opioid withdrawal

A 
Agitation/restlessness
Yawning
Muscle aches
Sweating
Anxiety
Increased tearing
Runny nose
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29
Q

Late signs of opioid withdrawal (trainspotting)

A 
Insomnia
Vomiting
Dilated pupils
Diarrhoea
Nausea
Piloerection
-->
followed by tachycardia, increase in respiratory rate and abdominal cramps

Advanced sign of opioid withdrawal = muscle spasm

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30
Q

Signs of cannabis withdrawal

A
  • Insomnia
  • reduced appetite
  • irritability
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31
Q

Nick Cave opiate intoxication

A

Euphoria, constricted pupils then drowsy, constipated then goes into respiratory depression, pupillary constriction

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32
Q

Cocaine + amphetamine intoxication

Alex Harding on night out

A

Initially increased energy, hyperactivity, diaphoresis euphoria, heightened self-esteem
Gets paranoid (vsual hallucinations)
Sensation of bugs crawling beneath the skin (formication)
Arrythmias and tachycardia
Goes home but doesn’t stop for food due to reduced appetite and nausea
Doesn’t sleep due to insomnia

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33
Q

Cocaine + amphetmaine withdrawal

Alex Harding after night out

A 
Feels depressed
Hypersomnia and vivid dreams
Increased appetite (insatiable)
When awake irritable, anxious and agitated
Headache
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34
Q

MDMA/ecstasy

Miley Cyrus - Molly

A 
Increased energy
Increase in empathy and extroversionn
Accelerated thinking
Euphoria
Really sociable and increased response to touch
Increased sweating
Jaw clenching
Increasead nausea and vomiting
Increased libido
Deaths asociated with dehydration annd hyperthermia
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35
Q

MDMA withdrawal

Miley Cyrus Slide Away video

A 
Depersonalisation
Derealisation
Depression
Insomnia
Anxiety
Difficulty concentrating
Fatigue
Loss of appetite/anorexia
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36
Q 
Cannabis intoxication
(Killer Mike)
A 
Relaxation
Intensified sensory experience
Red eyes
Paranoia / anxiety
Increased appetite
Dry mouth
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37
Q

Cannabis withdrawal

Killer Mike Living Black

A

Insomnia (on park bench)
Reduced appetite couldn’t eat
Irritable

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38
Q

LSD

Khyle in Boogie Shed

A 
Pupil dilation
Sweaty
Tachy
Palpitations, tremors
Incoordination dancing badly
Perceptual changes
-shape distortion
-stationary things are moving like the bar
-intense colours and sounds
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39
Q

Ketamine intoxication

The Weeknd I can’t feel my face

A 
Euphoria
Dissociation
Hallucinations
Muscle rigidity
Ataxia

Staggering around, face has rigid muscles feels amazing

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40
Q

Which pharmacological option is most suitable for managing cannabis withdrawal?

A

Benzos

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41
Q

Increased need for handling in babies is seen in withdrawal of which drug?

A

Nictotine

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42
Q

In Korsakoff’s psychosis which memory test will NOT be impaired?

A

Digit span

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43
Q

Severe personality disorder is a contraindication for the use of which drug used in addiction psychiatry?

A

Benzos

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44
Q

What’s the traid of Wernicke’s?

A

Wernicke’s encephalopathy is characterised by the triad of global confusion, ophthalmoplegia, and ataxia (classic triad only present in 10% of people)

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45
Q

Apart from alcohol dependency in which other scenarios might patients develop Wernicke’s?

A

Anorexia nervosa

Following gastric surgery

Malignancy

AIDS

Hyperemesis gravidarum

Prolonged total parenteral nutrition

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46
Q

What’s the associated mortality of Wernicke’s?

A

mortality of 10-20%.

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47
Q

Where are the lesions of Werncike’s?

A

The lesions (gliosis and small haemorrhages) of Wernicke’s encephalopathy occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, atrophy of these structures is specific for Wernicke’s encephalopathy.

Other affected sites include the hypothalamus, mediodorsal thalamic nucleus, colliculi and midbrain tegmentum.

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48
Q

Of those with Wernicke’s who are interested what % go on to develop Korsakoff?

A

Of those untreated, 80% go on to develop Korsakoff’s syndrome.

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49
Q

What should be avoided when thiamine deficiency is suspected as it can precipitate or exacerbate Wernicke’s?

A

IV glucose (thiamine replacement but be given first)

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50
Q

What’s the treatment of Wernicke’s?

A

IM/IV Pabrinex >500mg for 3-5 days (2 pairs TDS for 3 days then 1 pair TDS for 2 days)

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51
Q

What are the class A drugs?

A

Cocaine, crack, ecstasy, LSD, magic mushrooms, heroin, methamphetamine, and any injected class B substance

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52
Q

What’s the maximum prison sentence associated with class A drugs?

A

7 years

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53
Q

What are the class B drugs?

A

Cannabis, amphetamine, codeine, barbiturates, phoclonidime, ketamine, methylphenidate, synthetic cannabinoids, synthetic cathinones (eg mephedrone, methoxetamine)

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54
Q

Whats the maximum prison sentence associated with class B drugs?

A

5 years

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55
Q

What are the class C drugs?

A

Anabolic steroids, minor tranquillizers (benzodiazepines), gamma hydroxybutyrate (GHB), gamma-butyrolactone (GBL), piperazines (BZP - stimulant like legal high), khat

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56
Q

What’s the maximum prison sentence associated with class C drugs?

A

2 years

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57
Q

Which drug interferes with the conversion of aldehyde to acetic acid?

A

Disulfram

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58
Q

What’s the mechanism of action of disulfram?

A

binding irreversibly to aldehyde dehydrogenase
results in accumulation of acetyl acetaldehyde which causes flushing, nausea, vomiting, headache, tachycardia and palpitations when alcohol is consumed

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59
Q

How long does it take for symptoms to begin after drinking alcohol when taking Disulfram?

A

Symptoms start 5-15 minutes after drinking alcohol and last for several hours producing symptoms of nausea and headache.

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60
Q

What’s the class of Acamprosate?

A

Acamprosate is a structural analogue of gamma-aminobutyric acid (GABA)

It acts in a dose dependent fashion

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61
Q

What is the most common adverse effect varenicline?

A

Nausea

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62
Q

What’s the duration of NRT for most people maintaining abstinence from cigarettes?

A

For most people maintaining abstinence from cigarettes, the duration of treatment with NRT is 8-12 weeks (depending on which form of NRT is used and which dose is initiated), followed by a gradual reduction in dose.

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63
Q

When should Bupropion and Vareniciline be initiated in smoking cessation?

A

While the person is still smoking. The person must start Bupropion 7 days before stopping smoking.

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64
Q

When should Bupropion be avoided in smoking cessation?

A

Bupropion should be avoided in the following:

adolescents
pregnancy and breast feeding
history of bipolar disorder

Contraindicated in:

epilepsy
eating disorders

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65
Q

What’s the length of the usual course of Bupropion in smoking cessation?

A

After a usual course of 8 weeks, discontinuation reactions are unlikely and bupropion can be stopped without tapering the dose.

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66
Q

What are common side effects of Bupropion?

A

The most common adverse effects of bupropion include dry mouth, gastrointestinal disturbances, insomnia (which can be reduced by not giving the last dose at bedtime), headache, impaired concentration, and dizziness.

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67
Q

What’s the recommended course length of Vareniciline for smoking cessation?

A

The recommended course of treatment is 12 weeks

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68
Q

When should Vareniciline be avoided?

A

epilepsy

pregnancy and breast feeding

significant renal impairment

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69
Q

What is the lifetime prevalence of suicide in alcohol dependence?

A

7%

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70
Q

Whats the increased risk of developing Schizophrenia with regular cannabis use pre 15 years old?

A

People are 4.5 times more likely to be schizophrenic at 26 if they were regular cannabis smokers at 15, (than general population)

compared to 1.65 times for those who did not report regular use until age 18 (than general population)

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71
Q

Whats the increased risk of developing Schizophrenia with regular cannabis use?

A

2x

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72
Q

What very rare condition has IV heroin use been associated with (more in black men?)

A

Intravenous heroin use has been associated with nephropathy (very rare) probably mediated by bacterial infection. Heroin associated nephropathy is usually seen in African-American men (reasons unknown).

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73
Q

When do signs of alcohol withdrawal begin? And then do they peak?

A

The initial signs and symptoms of withdrawal begin from 6 to 48 hrs after drinking stops. They usually peak between 10-30 hours

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74
Q

What are the symptoms of alcohol withdrawal?

A

Sweating, agitation, nausea, tremor, irritability, and in a small number of cases transient hallucinations. These initial symptoms usually diminish by 48hrs.

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75
Q

Which percentage of people undergoing withdrawal experience delirium tremens?

A

5%

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76
Q

Whats the mortality rate of delirium tremens?

A

1-5%

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77
Q

How long after alcohol cessation does delirium tremens occur?

A

2-4 days

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78
Q

What are the risk factors for delirium tremens?

A

abnormal liver function, old age, severity of withdrawal symptoms, concurrent medical illness, and heavy alcohol use.

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79
Q

What’s the treatment for alcohol withdrawal?

A

Benzos

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80
Q

What is Suboxone?

A

Suboxone is a combination of four parts buprenorphine to one part naloxone. The latter is added to prevent addicts from injecting the tablets, as this was common when addicts were given pure buprenorphine tablets. Because it contains naloxone it is likely to produce intense withdrawal symptoms if injected, this does not occur when the tablet is swallowed as naloxone is not absorbed by the gut.

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81
Q

The legal high known as Mephedrone (Mcat) is most similar to what drug?

A

Ecstasy + amphetamines

It is chemically similar to cathinone, the active ingredient of the African Khat

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82
Q

What is the appearance and smell of Mephedrone/Mcat?

A

It can have a distinctive odour, reported to range from a synthetic fishy smell to the smell of vanilla and bleach, stale urine, or electric circuit boards.

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83
Q

What class of drug is Mephedrone?

A

Class B

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84
Q

Which drug does the legal high Piperazines mimic?

A

Ecstasy

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85
Q

What class of drug is Piperazine?

A

Class B

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86
Q

What’s the effect of the legal high GBL (gammabutyrolactone)?

A

euphoric, sedative, and anabolic effects (used in bodybuilding).

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87
Q

What class of drug is GBL?

A

Class C

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88
Q

What drug are Benzofuran compounds similar to?

A

Ecstacy

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89
Q

What class of drug do Benzofuran compounds belong to?

A

Class B

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90
Q

Ibuprofen is known to cause false positive results when testing for which illicit substance?

A

Cannabis

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91
Q

Which drugs can cause a positive cannabis result on urine drug screen?

A

NSAIDS

PPIs

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92
Q

Which drugs can cause a positive amphetamine result on urine drug screen?

A

Amantadine, penicillin, bupropion, ephedrine, phenothiazines, ranitidine, selegiline, trazodone, methylphenidate, phenylephrine

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93
Q

Which drugs can cause a positive benzo result on urine drug screen?

A

Sertraline

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94
Q

Which drugs can cause a positive cocaine result on urine drug screen?

A

Topical anaesthetics

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95
Q

Which drugs can cause a positive opioid result on urine drug screen?

A

Codeine containing preparations (e.g. Cough mixture), poppy seeds, verapamil, tonic water

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96
Q

Which methods are there for drug testing?

A

Drug testing can be done by the following methods:-

Urine

Oral fluid

Blood

Hair

Sweat

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97
Q

What’s the focus of motivational interviewing?

A

focuses on exploring and resolving ambivalence and centers on the motivational process that facilitates change

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98
Q

Who introduced motivational interviewing and when?

A

introduced by William Miller in 1983

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99
Q

What are the three key elements motivational interviewing is based on?

A

and is based on three key elements:-

Collaboration (rather than confrontation)

Evocation (drawing out rather than imposing ideas)

Autonomy (rather than authority)

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100
Q

What are the 4 principles of motivational interviewing?

A

Express empathy (see it from the client perspective)

Support self-efficacy (be positive and recognise previous successes and strengths)

Roll with resistance (be impartial and avoid conflict)

Develop discrepancy (help client see the discrepancy between current circumstances and future goals)

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101
Q

What is change talk in motivational interviewing?

A

Change talk is defined as statements by the client that reveals consideration of, motivation for, or commitment to change

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102
Q

What are types of change talk?

A

D - Desire (to change)

A - Ability (client recognising they can change)

R - Reason (client understands why change is needed)

N - Need (client believes they need to change)

C - Commitment (client intends to change)

A - Activation (client is ready, prepared and willing to change)

T - Taking steps (client is taking steps towards change)

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103
Q

What is the method of choice for detecting alcohol dependence in primary care?

A

AUDIT

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104
Q

AUDIT screening tool overview

A

10 item questionnaire

Takes about 2-3 minutes to complete

Has been shown to be superior to CAGE and biochemical markers for predicting alcohol problems

Minimum score = 0, maximum score = 40

A score of 8 or more in men, and 7 or more in women, indicates a strong likelihood of hazardous or harmful alcohol consumption

A score of 15 or more in men, and 13 or more in women, is likely to indicate alcohol dependence

AUDIT-C is an abbreviated form consisting of 3 questions

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105
Q

FAST screening overview

A

4 item questionnaire

Minimum score = 0, maximum score = 16

The score for hazardous drinking is 3 or more

With relation to the first question 1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits

If the answer to the first question is ‘never’ then the patient is not misusing alcohol

If the response to the first question is ‘Weekly’ or ‘Daily or almost daily’ then the patient is a hazardous, harmful or dependent drinker. Over 50% of people will be classified using just this one question

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106
Q

Questions asked in FAST screen?

A
  1. MEN: How often do you have EIGHT or more drinks on one occasion?
    WOMEN: How often do you have SIX or more drinks on one occasion?
  2. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
  3. How often during the last year have you failed to do what was normally expected of you because of drinking?
  4. In the last year has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?
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107
Q

CAGE questions

A

C Have you ever felt you should Cut down on your drinking?

A Have people Annoyed you by criticising your drinking?

G Have you ever felt bad or Guilty about your drinking?

E Have you ever had a drink in the morning to get rid of a hangover (Eye opener)?

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108
Q

What’s a positive score on CAGE?

A

2 or more

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109
Q

Which alcohol screening tool was developed for use in a busy A&E department to detect hazardous drinking?

A

PAT(Paddington Alcohol Test),.

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110
Q

RAPS4 screen

A

R (remorse)Have you had a feeling of guilt or remorse after drinking?

A (amnesia)Has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember?

P (performance)Have you failed to do what was normally expected of you because of drinking?

S (starter drinker behaviour)Do you sometimes take a drink when you first get up in the morning?

A ‘yes’ answer to at least one of the four questions suggests that your drinking is harmful.

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111
Q

What’s SASQ screening tool?

A

SASQ(Single alcohol screening questionnaire), asks only one question, when was the last time you had more than x alcoholic drinks in one day? (Where x is 8 for men and 6 for women). An answer of within 3 months indicates harmful or hazardous drinking

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112
Q

Which medication is effective in alcohol withdrawal is advised against as it carries a high risk of respiratory depression?

A

Clomethiazole (heminevrin)

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113
Q

What’s the treatment of choice for associated hallucinations in alcohol withdrawal?

A

For associated hallucinations, haloperidol is the treatment of choice

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114
Q

Cannabis (heavy use) lasts in urine for?

A

14-28 days

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115
Q

Cannabis (single use) lasts in urine for?

A

3 days

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116
Q

Alcohol lasts in urine for?

A

12 hours

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117
Q

Standard drugs included in a urinalysis screen include?

A

Cannabis

Amphetamine

Cocaine

Methadone

Benzodiazepines

Opiates

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118
Q

According to the UK Department of Health, what quantity of alcohol is considered safe to consume during pregnancy?

A

None

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119
Q

What’s the risk of drinking alcohol in the first 3 months of pregnancy?

A

increased risk of miscarriage

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120
Q

What does NICE say about drinking in pregnancy?

A

Women should be advised that if they choose to drink alcohol while they are pregnant they should drink no more than 1-2 UK units once or twice a week.

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121
Q

The Department of Health currently recommends weekly safe drinking limits of what for men and women?

A

14 U for men and 14 U for women

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122
Q

Which type of amnesia is characteristic of Korsakoff’s syndrome?

A

Korsakoff’s syndrome results in anterograde amnesia

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123
Q

Whats the most reliable indicator of recent alcohol use

A

GGT is the most reliable indicator of recent alcohol use

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124
Q

What are the nice guidelines for opioid detox?

A

The NICE Guidelines on Opioid Detoxification make the following general recommendations.

Methadone (opioid agonist) or buprenorphine (partial agonist at the µ opioid receptor) should be offered as the first-line treatment in opioid detoxification.

Alternatives include: alpha-2 adrenergic agonists e.g. clonidine and lofexidine

Ultra-rapid detoxification under general anaesthesia or heavy sedation (where the airway needs to be supported) must not be offered.

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125
Q

Which drugs are are licensed as substitute opioids for the management of opioid dependence?

A

In the UK, only methadone and buprenorphine are licensed as substitute opioids for the management of opioid dependence

126
Q

Which drug is licensed for symptomatic relief during opioid detoxification?

A

In addition, lofexidine is licensed for symptomatic relief during opioid detoxification

127
Q

What’s the goal of opioid maintenance therapy?

A

The goal of maintenance therapy is harm reduction and stabilization of lifestyle.

128
Q

Symptoms of alcohol intoxication

A

Poor concentration

Impaired reaction times

Conjunctival injection

Pinpoint pupils

Poor coordination

Memory difficulties

Impaired judgement

Impaired sense of time and space

129
Q

What was Project MATCH?

A

studied which types of alcoholics respond best to which forms of treatment. Three types of treatment were investigated:-

Cognitive Behavioural Coping Skills Therapy, focusing on correcting poor self-esteem and distorted, negative, and self-defeating thinking.

Motivational Enhancement Therapy, which helps clients to become aware of and build on personal strengths that can help improve readiness to quit.

Twelve-Step Facilitation Therapy administered as an independent treatment designed to familiarize patients with the AA philosophy and to encourage participation.

130
Q

What was the conclusion of Project MATCH?

A

It found that the three psychological therapies tested were equal in effectiveness

131
Q

What is the most effective way to reducing alcohol related harm?

A

Making alcohol less affordable

132
Q

Which medical problem presenting with painful haematuria can chronic ketamine use cause?

A

There are case reports of chronic ketamine use causing ulcerative cystitis

133
Q

What is the maximum duration that benzodiazepines should be prescribed for anxiety according to Maudsley Guidelines?

A

4 weeks

134
Q

What are the physical withdrawal symptoms from benzos?

A 
Stiffness
Weakness
GI disturbance
Paraesthesia
Flu-like symptoms
Visual disturbance
135
Q

What are the psychological withdrawal symptoms from benzos?

A 
Anxiety
Insomnia
Nightmares
Depersonalisation
Decreased memory and concentration
Delusions and hallucinations
Depression
136
Q

What should be done for patients on short acting benzodiazepines who are keen to withdraw from them?

A

Patients on short acting benzodiazepines who are keen to withdraw from them should first be converted to diazepam. This is due to the fact that diazepam has a longer half-life and so tends to produce less severe withdrawal.

137
Q

Equivalent doses of 10mg diazepam

A 
Lorazepam1mg
Lormetazepam1mg
Nitrazepam10mg
Oxazepam30mg
Temazepam20mg
Chlordiapoxide25mg
138
Q

What’s a psychiatric side effect of Vareniciline?

A

Patients using varenicline are at an increased risk of suicidal thoughts

Excercebates underlying psych illness including depression

139
Q

Which is more effective Vareniciline or Bupropion?

A

Vareniciline

140
Q

The FDA issued what safety announcement about varenicline

A

may be associated with a small, increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease.

141
Q

Which of the following is indicated in the management of problem gambling associated with impulse control disorders?

A

Naltrexone

142
Q

What pharmacological management options are there for problem gambling?

A

Trials have shown that selective serotonin reuptake inhibitors (SSRIs), naltrexone and mood stabilisers are all effective, although none has demonstrated superiority over others.

143
Q

What is true of alcoholic hallucinosis?

A

Occurs in clear consciousness

144
Q

What is alcoholic hallucinosis?

A
  • AKA Alcohol induced psychotic disorder
  • unstructured auditory or visual hallucinations that occur either during or after a period of heavy alcohol consumption
  • Lasts less than one week.
  • Good response to antipsychotics
145
Q

What is Marchiafava-Bignami disease?

A

Rare disorder (250 cases total) seen in those with alcoholism and malnutrition (M>F).

First described in 1898 in Italian red wine drinkers

Patients often present with non specific clinical features such as a motor or cognitive disturbance (dementia, spasticity, dysarthria, gait changes). It is characterised by progressive demyelination and subsequent necrosis of the corpus callosum and adjacent subcortical white matter.

146
Q

How long does home detoxification from alcohol usually take?

A

Home detoxification is usually complete within 5-9 days

147
Q

When is inpatient alcohol detox preferred?

A

Inpatient detox is preferred when there is:

  • high risk of seizures or DT (past incidence, present symptoms or high mean cell volume)
  • psychiatric morbidity (suicide risk)
  • debilitating physical health problem
  • Wernicke’s/Korsakoff’s
  • homelessness or social difficulties
148
Q

What’s the most common ocular abnormality seen in Wernicke’s?

A
  • Nystagmus (usually horizontal) is the most common ocular abnormality seen in Wernicke’s (see in 85% of cases)
  • Others include bilateral 6th nerve palsy, conjugate gaze palsy, pupillary abnormalities, retinal haemorrhage, ptosis, scotomata
  • In general eye signs are usually bilateral but not symmetrical
149
Q

By how many times is a person with a first degree relative with alcohol dependence likely to develop the same condition when compared to a person with no family history?

A

4x

150
Q

According to the ICD-10 how many criteria of craving, tolerance, and withdrawal does the patient need to have to receive a diagnosis of dependency?

A

3

151
Q

Criteria for alcohol dependence syndrome according to ICD 10 - how many needed to score and present for how long?

A

Compulsion

Loss of control

Physiological withdrawal

use of alcohol to relieve from withdrawal symptoms

Tolerance

Neglect of rest of life

Persistence despite clear evidence of harmful consequence

152
Q

What are Edwards and Gross criteria for alcohol dependence?

A 
Edwards and Gross criteria
Narrowing of the drinking repertoire
Salience (prominence) of drink seeking behaviour
Tolerance
Withdrawal symptoms
Relief of withdrawal by further drinking
Compulsion to drink
Rapid reinstatement of symptoms after a period of abstinence
153
Q

Which aspect of memory is most severely affected in the Korsakoff syndrome?

A

Episodic

154
Q

Opioid detoxification should not be routinely offered to?

A

With a medical condition needing urgent treatment.

In police custody, or serving a short prison sentence or a short period of remand, consideration should be given to treating opioid withdrawal symptoms with opioid agonist medication.

Who have presented to an acute or emergency setting, the primary emergency problem should be addressed and opioid withdrawal symptoms treated, with referral to further drug services as appropriate.

155
Q

What’s Pellagra caused by?

A

Pellagra is caused by a deficiency of vitamin B3 (niacin).

156
Q

What are the three Ds of Pellagra?

A

Pellagra is classically defined by ‘the three Ds’:-

Diarrhoea

Dermatitis

Dementia

157
Q

Dependence to what can result in pellagra?

A

Alcohol

158
Q

What s the most common symptom of benzodiazepine withdrawal?

A

Insomnia is the most common symptom of benzodiazepine withdrawal.

159
Q

Which of the following is not covered under the Misuse of Drugs Act 1971?

A

Amyl nitrite (poppers)

160
Q

According to the National Treatment Outcomes Research Study (NTORS), what is the most common crime in those with drug dependence?

A

Shoplifting

161
Q

What % of offender with alcohol dependence account for the majority of crimes committed?

A

10% of offenders account for 76% of the crimes

162
Q

How long do the NICE guidelines suggest a period of inpatient opioid detoxification should take?

A

4 weeks

163
Q

What is the most common presenting feature of Wernicke’s encephalopathy?

A

Ataxia

164
Q

The effects of oral methadone last for

A

12-24 hours

165
Q

The highest levels of binge drinking occur in which age group?

A

The highest levels of binge drinking occur in people aged 16-24

166
Q

Binge drinking prevalence

A

21% in men 9% in women

167
Q

Alcohol dependence prevalence

A

6% men 2% women

168
Q

Lifetime prevalence use of illicit drugs in Europe

A 
Cannabis22.5%
Cocaine4.1%
Amphetamine3.7%
Ecstasy3.3%
Opioids*0.5%
169
Q

Which of the following should be avoided with low blood pressure in alcohol detox?

A

Lofexidine

170
Q

What is used for ultra rapid opiate detoxification?

A

Naloxone

171
Q

What is most suggestive of a chronic alcohol problem?

A

Multiple spider naevi

172
Q

What is codependency in addictions?

A

Codependencyrefers to a situation whereby a person becomes psychologically dependent on the behaviour of an ‘addict’.

The issue is significant as the codependent person may encourage (not necessarily consciously) the addiction and perpetuate it so as to protect their role

173
Q

What is enabling behaviour in addictions?

A

Enabling behaviouroccurs when a codependent person, helps or encourages an addict to continue using drugs, either directly or indirectly. An examples could be a spouse giving the addict money to buy drugs.

174
Q

What are alcoholic blackouts? What’s the implication on long term cognitive impairment?

A

refers to transient memory loss induced by intoxication (anterograde amnesia). There is no associated loss of consciousness. These blackouts are not pathognomic of alcohol

Blackouts do not predict long term cognitive impairment

175
Q

What illusion does PCP create?

A

ability to induce the illusion of euphoria, omnipotence, superhuman strength, and social and sexual prowess.

176
Q

What’s the best management for PCP intoxication?

A

Benzos

177
Q

Percentage of general population who drank alcohol in

the last week in the UK?

A

67% men; 53% women

178
Q

Percentage of adults who drank above the recommended
limits among those who drank alcohol in the last week

A

55% men (24% of general population); 53%

women (18% of general population)

179
Q

Percentage of school pupils (aged 11-15) who had drunk
alcohol at least once

A

43%

180
Q

Patients presenting to primary care that consume alcohol
at harmful or hazardous levels

A

20%

181
Q

Annual prevalence of hazardous drinking (AUDIT score

>= 8) in UK households

A

38% of men; 15% of women;
27% of White
adults,
18% of Black adults
8% South
Asian adults

182
Q

Peak age of hazardous drinking

A

16 to 19 (women); 20-24 years (men)

183
Q

Prevalence of alcohol dependence

A

74 per 1,000 overall; 119 per 1,000 men and

29 per 1,000 women.

184
Q

Number of all hospital attendees/admissions that are

alcohol related

A

1 in 16 hospital admissions (Pirmohamed,
2000);

1 in 6 A&E attendees (this rises to 8
in 10 during peak hours) (HEA, 1998).

185
Q

Age-specific use patterns in alcohol dependent people

A

Age at first drink (13-15),
age at first
intoxication (15-17)
age at first
‘problem’ related to alcohol (16-22) is
essentially the same as the general
population for alcohol dependent patients.
But the age at death is around 60 years –
very premature.

186
Q

Alcohol use during pregnancy

A

One in 10 pregnant women drank in the

last week

187
Q

Percentage of UK adults (16 to 59) who took an illicit

drug in the last year

A

1 in 12 (8.3%);
frequent users i.e.
>once/month = 2.8%
(Cannabis (6.4%)
followed by powder cocaine (1.9%) and
ecstasy (1.3%))

188
Q

Percentage of young adults (16 to 24) taking any drug

in the last year in the UK

A

1 in 6 (16.3%); frequent users = 5.1%

189
Q

Percentage of adults aged 16 – 59 had taken a Class A

drug in the last year

A

2.6%

190
Q

Percentage of school pupils who took an illicit drug in

the last year in the UK

A

12% (raises to 17% if all past exposure s are

considered)

191
Q

Percentage of drug users in the last year who use

multiple substances

A 
61% when alcohol is also included; 7% for 
other drugs (not alcohol)
192
Q

The most commonly reported age for first taking

drugs.

A

Cannabis - 16 years; powder cocaine and

ecstasy - 18 years

193
Q

Average duration of drug use among regular users.

A

Cannabis - 6.2 years; powder cocaine (4.4
years) or ecstasy (3.9 years)

194
Q

What’s the ICD10 has a diagnostic code for ‘harmful use’ of alcohol mean?

A

the actual damage is caused to the
drinker physically or mentally, but he has no dependence pattern (yet).

195
Q

What are Cloninger’s classification of alcohol dependence?

A 
Type 1
Milieu limited 
Males and females
Loss of control
No strong family history 
Not much criminality 
Starts >25years 
Type 2
Male limited
Males usually
 Inability to abstain
Strong heritability
Antisocial traits high
Starts <25 years
196
Q

Jellinek’s classification of alcohol dependence

A

Alpha α Psychological dependence; undisciplined not progressive; no
withdrawal; major problems are in interpersonal domain only

Beta β Physical damage but no dependence

Gamma γ Loss of control plus physical dependence. Withdrawal seen; earlier
stages are similar to alpha – most common among AngloSaxons

Delta δ No loss of control but unable to abstain e.g., in France this may be
socially accepted – no disapproval or interpersonal problems

Epsilon ε Dipsomania – binges and bouts

197
Q

Pharmacokinetics of alcohol

A

Intercalates into the fluid cell membrane; decreases NMDA sensitivity;
increases GABA sensitivity; downregulates calcium channels; upregulates nicotine receptor gated
sodium channels.

198
Q

Pharmacokinetics of alcohol

A

Intercalates into the fluid cell membrane; decreases NMDA sensitivity;
increases GABA sensitivity; downregulates calcium channels; upregulates nicotine receptor gated
sodium channels.

199
Q

Prevalence of heroin use in the UK

M:F

A

The current prevalence of heroin use in the UK is around 1%

(male-to-female ratio of 2:1), with most treatment seekers being in their 20s

200
Q

Which types of receptors are important in opioid physiology?

A

3 receptors are important in opioid physiology. Mu (μ), kappa (κ) and delta (δ) – all three are G coupled protein

201
Q

What’s the half life of heroin?

A

<3 minutes

202
Q

What’s the potency of Buprenorphrine compared to Morphine?

A

40 times more potent at
receptor level, but a
partial agonist

203
Q

Symptoms of benzo intoxication

A

Slurred speech, incoordination, unsteady gait,
nystagmus , impairment in attention or memory, stupor or coma
behavioural changes
such as inappropriate sexual or aggressive behaviour, mood lability, and impaired
judgment.

204
Q

What is flumazenil?

A

Flumazenil is a specific benzodiazepine antagonist used in A&E/ICU to reverse the effects of the benzodiazepines

205
Q

Mechanism of action of amphetamines?

A

Amphetamines block catecholamine (DA & NEN especially) reuptake and
stimulate their release from vesicles.

206
Q

Mechanism of action of cocaine?

A

It has a potent dopamine reuptake blockade

effect

207
Q

Physical adverse effects of cocaine use

A 
Nasal perforation on snorting.
Nonhemorrhagic cerebral infarctions.
Subarachnoid, intraparenchymal, and intraventricular hemorrhages. 
TIAs
Seizures (3 to 8% of A&amp;E visits)
Myocardial infarctions and arrhythmias
208
Q

Symptoms of caffeine intoxication

A

Caffeine intake in excess of 250 mg (>2-3 cups at once) can produce restlessness,
nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle
twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of
inexhaustibility and psychomotor agitation

209
Q

Half life and peak concentration of caffeine

A

The half-life of caffeine in the human
body is 3 - 10 hours and the time of peak concentration is 30 to 60 minutes.

210
Q

Does caffeine cross the blood-brain barrier?

A

Caffeine readily crosses the blood-brain barrier and

211
Q

Nicotine withdrawal symptoms

A

The features of withdrawal reaction
are dysphoric or depressed mood, insomnia, irritability, frustration, or anger, anxiety,
difficulty concentrating, restlessness, decreased heart rate and increased appetite or weight
gain.

These symptoms begin a few hours after the last cigarette, peak 2 to 3 days after
quitting, and become less intense over 1 to 3 weeks. Smokers also report cravings for
cigarettes, which can last for a longer period

212
Q

Which hepatic enzyme is nicotine known to stimulate?

A

CYP1A2

213
Q

What’s the mechanism of action of nicotine?

A

Nicotine stimulates central nicotinic acetylcholine receptors and improves alertness.

214
Q

What’s the mechanism of action of inhalants?

A

Inhalants generally act as CNS depressants

215
Q

What is the common factor model for substance abuse and psychiatric illness?

A

Genetic vulnerability, antisocial personality traits and low social status (predisposing factors)

216
Q

What is the secondary use model for substance abuse and psychiatric illness?

A

Patients use substances to alleviate dysphoria or medicate symptoms and reduce social isolation

217
Q

What is the supersensitivity model for substance abuse and psychiatric illness

A

Mental ill patients are unusually sensitive to negative social and health consequences of substance exposure

218
Q

What is the secondary illness model for substance abuse and psychiatric illness (popular with lay public)?

A

Substance misuse leads to mental illness by a mechanism similar to kindling or behavioural sensitisation

219
Q

What is pathological intoxication?

A
  • a severe behavioural reaction that develops rapidly after consumption of a small amount of alcohol
  • includes confusion, hallucinations, high psychomotor agitation, impulsive/aggressive behaviour
  • lasts a few hours, usually terminates in prolonged sleep
220
Q

What is primary alcoholic dementia?

A

Persistent dementia attributable to the direct toxic effect of alcohol on the brain (contested diagnosis)

221
Q

Other than clinical assessment what is the most valuable diagnostic tool for Wernicke’s?

A

MRI (93% specificity, 53% sensitivity)

222
Q

How would you manage a healthy/uncomplicated patient with alcohol dependence during detox?

A

minimum 300mg PO thiamine

223
Q

How would you manage a patient at high risk of Wernicke’s during detox?

A

250mg IM/IV Pabrinex for 3-5 days

224
Q

How quickly do signs/symptoms of Wernicke’s respond to treatment?

A

Ophthalmoplegia = hours

Cognitive impairment = longer

225
Q

Other than anterograde amnesia, what are the features of Korsakoff’s?

A

Confabulation and apathy

Relative preservation of attention + procedural and working memory

226
Q

Where are lesions found in Korsakoff’s?

A

Dorsomedial thalamus

227
Q

What is alcohol related cerebellar degeneration?

A

Degeneration of purkinje cells in the cerebellar cortex due to alcohol induced damage

228
Q

What percentage of chronic alcoholic suffer with cerebellar degeneration?

A

40%

229
Q

What are the symptoms of cerebellar degeneration?

A

Limb ataxia, dysarthria, nystagmus (rare)

230
Q

What are the signs/symptoms of hepatic encephalopathy?

A

Metabolic flapping tremor (asterixis), hyperreflexia, extensor plantar respones (babinski +ve), altered sensation

231
Q

What is hepatocerebral degeneration?

A

Residual neurological deficit post encephalopathy

Includes: tremor, choreoathetosis, dysarthria, ataxia and dementia

232
Q

What are the clinical manifestations of central pontine myelinosis?

A

Pain sensation in limbs, bulbar palsy, quadriplegia, disordered eye movements, vomiting, confusion, coma, locked in syndrome

233
Q

Other than chronic alcoholism, which other conditions can lead to CPM?

A

CLD i.e. Wilson’s, malnutrition, anorexia, burns, cancer, Addison’s, severe electrolyte disturbance

234
Q

What is the pathophysiology of alcoholic pancreatitis?

A

Calcium salts are chelated by free fatty acids generated by lipase following damage to the pancreas. These are deposited in the retroperitoneum resulting in back pain and hypocalcaemia. Hypoalbuminaemia and hypomagnaesaemia may also feature.

235
Q

How does pancreatitis induced hypocalcaemia affect PTH levels?

A

They may be normal, suppressed or elevated

236
Q

How should pancreatitis induced hypocalcaemia be treated?

A

Parenteral calcium and magnesium replacement

Assess Vit D status to rule out malabsorption

237
Q

What are the features of stimulant induced psychosis?

A

Similar to schizophrenia (particular paranoia)

Important differences include: 
absence of prominent negative symptoms
predominance of visual hallucinations
associated hyperactivity
generally appropriate affect
disinhibited sexual behaviours
confusion and incoherence
almost no formal thought disturbance
238
Q

How is stimulant induced psychosis diagnosed?

A

Rapid resolution of symptoms (within a few days) or positive drug screen

239
Q

If you were going to treat a patient with stimulant induced psychosis what would you use?

A

Short term haloperidol or other antipsychotic

240
Q

Name two cannabis related syndromes

A
  1. Hemp insanity (florid psychosis after high doses of high potency cannabis)
  2. Amotivational syndrome (associated with long term heavy use - loss of motivation to persist in tasks requiring prolonged effort/attention)
241
Q

What symptoms are common in children born to mothers who actively consume cannabis during pregnancy?

A

Mild attentional problems and impulsivity

242
Q

Name two hallucinogen related syndromes

A
  1. ‘Bad trip’ (similar to acute panic reaction but longer duration, can produce true psychotic symptoms, usually stops when effects of drug wear off)
  2. Hallucinogen persisting perception disorder (re-experiencing perceptual symptoms following cessation of hallucinogen use i.e. geometric hallucinations, false perceptions of movement in periphery, flashes or intensified colours)
243
Q

What can trigger Hallucinogen persisting perception disorder?

A

Emotional stress, sensory deprivation, use of another psychoactive substance

244
Q

What are the risk factors for alcoholism?

A

Sociocultural factors: disruption of family structure, domestic violence, social networks that use alcohol, recent immigration, small area deprivation

Genetic factors: specific gene loci

Biomarkers: low 5HT, 5HIAA, MAO

245
Q

What are the sociocultural risk factors for smoking tobacco?

A

Low school achievement, young among peer cohort, poorer relationship with family, low household income

246
Q

What are the sociocultural risk factors for using illicit substances?

A

Peer drug use, single parent, homelessness, poor educational attainment, neighbourhood disadvantage, unemployment

247
Q

Dextromethorphan can cause a false positive drug screen result for which illicit substance?

A

PCP

248
Q

What is the advantage of using a symptom triggered detox regimen (alcohol)?

A

Faster control, fewer total BZDs needed, avoids oversedation

249
Q

What is the first line alternative to BZDs in alcohol detox regimens?

A

Carbamazepine

250
Q

12 step AA facilitatation programme

A

The 12 steps are

  1. Accept powerlessness in front of alcoholism.
  2. Admit only a Greater power can help
  3. Make a decision to turn our to the care of God as you understand Him
  4. Make a searching and fearless moral inventory.
  5. Admit wrongs done to others.
  6. Become entirely ready for removal of these defects.
  7. Ask Him to help now.
  8. Be willing to make amends to all
  9. Make direct amends where possible
  10. Continue personal inventory.
  11. Prayer and meditation.
  12. Practice and preach.
251
Q

How should opioid overdose be managed

A
  1. Airway (A-E)

2. Naloxone

252
Q

What harm-reduction advice can be given to patients who use opioids?

A
  1. Don’t use when alone
  2. Don’t combine with other drugs/ETOH
  3. Avoid IV
  4. If using IV: inject in direction of blood flow/rotate injection sites/ensure complete dissolution before injection/new syringe and needle each time/use sterile water/avoid lemon juice/never share equipment (risk of emboli and infection)
253
Q

What drug can be used to prevent relapse in opioid dependence?

A

Naltrexone (small evidence base)

254
Q

NICE guidelines for opioid detox

A

For all patients who are opioid dependent and have expressed an informed choice to become
abstinent, services should:
o Offer detoxification readily;
o Provide detailed information about detoxification especially the withdrawal
experience, management approaches, loss of opioid tolerance on successful
detoxification and so the risk of intoxication rises significantly.
o Offer buprenorphine or methadone as first line treatment, with due consideration to
service user’s preference.
o Detoxification should normally be started with the same medication as being used for
maintenance in patient.
o Consider lofexidine, especially for those with mild or uncertain dependence, but
warn patients that this necessitates the use of adjunct medications to manage
withdrawal symptoms such as nausea, vomiting and shivering
o Lofexidine detox outcomes are no better than for buprenorphine or methadone;
o Do not routinely use drugs such as benzodiazepines, minor analgesics, or
antidiarrhoeals to manage opioid withdrawal symptoms.

255
Q

Offer a community based detoxification programme routinely, except when:

A

Previous failure of community detoxification.
Significant additional physical or mental health problems
Polydrug detoxification
Significant social problems

256
Q

How long should NRT be continued after cessation?

A

2 weeks

257
Q

Is there any difference in the efficacy of different NRT preparations?

A

No (but higher dosage is better for heavier smokers)

258
Q

Can multiple NRT products be used together?

A

Yes

259
Q

Which NRT product has the best compliance?

A

Patch

260
Q

How does nicotine release differ dependent on preparation?

A

Patch: slowest but most consistent release
Nasal spray: fastest release (blood nicotine levels peak after 5-10 minutes)
Gum/inhaler: peak at 20 minutes
(smoking quicker that all of the above)

261
Q

Is NRT safe for patients with CVD?

A

Yes (if stable)

262
Q

How long should be left after an unsuccessful attempt at smoking cessation using pharmacological intervention before trying again?

A

6 months

263
Q

What percentage of pathological gamblers have co-morbid substance misuse?

A

30-50%

264
Q

What are the 5 types of internet addiction?

A
  1. cybersexual
  2. cyberrelationship
  3. net compulsion i.e. gambling, shopping
  4. information overload i.e. database searching
  5. gaming addiction

*Internet addiction only features in DSMV (not ICD)

265
Q

What is oniomania?

A

Compulsive buying characterised by behaviour that is uncontrollable, markedly distressing, time consuming and/or resulting in family/social/vocational/financial difficulties

Must not only occur in context of hypo/mania

(not recognised in either diagnostic manual)

266
Q

Why is anabolic steroid abuse classified under disorders of physiology in ICD-10?

A

Because it is not psychoactive in nature

267
Q

What are the 3 patterns of anabolic steroid abuse?

A
  1. Cycling
  2. Stacking
  3. Pyramiding
268
Q

What are the unwanted effects of anabolic steroid use?

A 
Aggression/violence
Psychosis
Mania
Depression
Endocrine abnormalities resulting in acne (50% of people), testicular atrophy +/or gynaecomastia (1/3 of people)
269
Q

What are the different types of legal highs?

A
  1. Stimulant like i.e. mephedrone (AE = serotonin syndrome, psychosis, hyperthermia, CV symptoms)
  2. Psychedelic-like i.e. DMT
  3. Cannabis-like i.e. spice (AE = paranoia, psychosis, intense anxiety, seizures)
  4. Benzomimetic i.e. flubromazepam (AE = respiratory depression, withdrawal seizures)
  5. Dissociative anaesthetic-like i.e. mexxy (AE = headache, psychotic symptoms, nausea, cognitive impairment)
270
Q

What is the most common non-genetic cause of LD?

A

Foetal Alcohol Syndrome

271
Q

What are the features of FAS?

A

Intellectual impairment, facial dysmorphia, disruptive behaviour

272
Q

Can medications to aid alcohol abstienence be used in pregnancy?

A

No - offer psychosocial support instead

273
Q

What are the risks of opiate use during pregnancy?

A

Infection secondary to injecting, drug induced stillbirth, premature birth, antenatal complications e.g. haemorrhage, low birth weight, microcephaly, neonatal abstinence syndrome

274
Q

Is heroin or methadone more likely to induce withdrawal in the newborn?

A

Methadone (60-80% more likely)

275
Q

What impact does maternal cocaine use have on newborns?

A

Small for Gestational Age

Microcephaly

276
Q

What impact does maternal cannabis use have on newborns?

A

Low Birth Weight (2x risk)

?negatively affects neurodevelopment

277
Q

What are the features of neonatal alcohol withdrawal syndrome?

A

Onset 3-12 hours after birth

Hyperactivity, irritability, poor sucking, tremors, seizures, poor sleeping patterns, sweating, hyperphagia

May be followed by FAS

278
Q

What are the features of neonatal barbiturate withdrawal syndrome?

A

Irritability, severe tremors, hyperacusis, excessive crying, diarrhoea, vomiting, increased tone, disturbed sleep

279
Q

What are the features of neonatal cannabis withdrawal syndrome?

A

Fine tremors, hyperacusis, prominent Moro reflex

Usually mild and does not require treatment

280
Q

What are the features of neonatal nicotine withdrawal syndrome?

A

Fine tremors, subtle neonatal behaviours i.e. poor self-regulation and increased need for handling

281
Q

What are the features of neonatal opiate withdrawal syndrome?

A

Onset 24-48h after birth but may not appear for 3-4 days

Hyper-irritability, GI dysfunction, respiratory distress, vague autonomic symptoms (i.e. yawning, sneezing, mottling, fever), high pitched cry, increased tone, exaggerated reflexes, loose stools leading to electrolyte disturbance and diaper dermatitis

282
Q

What are the features of neonatal antidepressant withdrawal syndrome?

A

Jitteriness, respiratory distress

More commonly observed with short acting SSRIs i.e. paroxetine

283
Q

What are the features of neonatal benzodiazepine withdrawal syndrome?

A

Neonatal benzodiazepine withdrawal syndrome presents with hypotonia and lethargy, and may persist from hours to months after birth

284
Q

Ebstein’s anomaly is sometimes associated which drug other than lithium?

A

Diazepam

285
Q

What is the lifetime prevalence of psychiatric disorder in long term cocaine users?

A

50-80%

286
Q

What score on Short Alcohol Withdrawal Scale means need for pharmacological treatment?

A

12

287
Q

How long can cocaine be detected in urine drug screen?

A

2-4 days

288
Q

How long can heroin be detected in urine drug screen?

A

Up to 3 days

289
Q

Which receptor does caffeine act on?

A

Adenosine (antagonis

290
Q

What’s the common cause of death due to GBH?

A

Aspiration pneumonia

291
Q

According to DSM 4 consumption above which dose is considered caffeinism?

A

250mg

292
Q

What’s a potentially dangerous side effect of clinidine when used for treating opioid dependence?

A

Hypotension

293
Q

What’s abstinence violation?

A

“I had a drink therefore I am a drinker again”

294
Q

Tolerance is least likely to develop for which symptom of amphetamine use?

A

Increased blood pressure

295
Q

% of patients taking benzos for a year that develop dependence?

A

40%

296
Q

1 year prevalence of substance misuse according to Steel et al

A

1 in 25

297
Q

Following sudden cessation of alcohol on a dependent patient, the risk of seizure is high during?

A

First 24 hours

298
Q

A man after completing his opioid detoxification is highly motivated to remain on treatment and wants advice about maintaining it. Which of the following drugs is best suited in this situation?

A

Naltrexone

299
Q

Which drug is related to anandamide?

A

Cannabis

300
Q

Drugs which interfere with ionotropic receptors or ion channels

A

Alcohol, nicotine, benzodiazepines, ketamine

301
Q

Drugs which interfere with G coupled receptors

A

Opioids, cannabinoids, y-hydroxybutyrate (GHB)

302
Q

Drugs that target monoamine transporters

A

Amphetamine, ecstasy, cocaine

303
Q

Apart from hallucinogens the drug capable of producing bad trips and persistent flashbacks is

A

Cannabis

304
Q

Chronic harmful effects of cocaine use

A

possible neuro-toxicity, hepatotoxicity, and possible chronic cognitive impairment

305
Q

Signs of inhalant intoxication

A

dizziness, nystagmus, incoordination, slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor, generalized muscle weakness, blurred vision or diplopia, stupor or coma and euphoria

A recent inhalant user may have rashes around nose and mouth; unusual breath odours; the residue of the inhalant substances on body or clothes; and signs of ocular and oropharyngeal irritation

306
Q

one year prevalence of clinical depression among those who have alcohol dependence

A

25-30%

307
Q

The prevalence of alcohol related problems in a community is linked to the

A

Per capita alcohol consumption

308
Q

long term cocaine users arelikely to have abnormalities in which cognitive domain?

A

sustained attention

309
Q

Which nutrient when deficient would result in refractoriness when treating Wernicke’s encephalopathy?

A

Magnesium

310
Q

What are the physiological disturbances associated with long-term use of ketamine?

A

Renal membrane nephropathy

311
Q

What are the physiological disturbances associated with long-term use of amphetamine?

A

Hypertension

312
Q

What are the physiological disturbances associated with long-term use of heroin?

A

Renal membrane nephropathy

MB (16 decks)

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